Consumers, patients, advocates, and physical therapists: it is time to have your voice heard.
Texas HB 1039 - Patient Access To Physical Therapy - has received a public hearing with the House Public Health Committee. The hearing is scheduled for Wednesday, April 10 at 8:00 am in Room E2.012.
Under current state law, Texans are prohibited from receiving physical therapy treatment unless they have first obtained a referral from another provider. This is not a regulation driven by your insurance plan - it is state law. HB 1039 does not change a physical therapist's scope of practice whatsoever. What it does is provide a patient with the opportunity to be evaluated AND treated by a physical therapist for 45 days or 20 visits (whichever comes first) before a referral from another provider would be required to continue care.
Why is this bill important for Texans?
Evidence and data are both an integral part of the scientific method - or so I thought. Here I was thinking that logic should provide a foundation for clinical reasoning and critical thinking. Crazy me.
If you are going through the effort and the expense (both in time and dollars) to collect data and accrue evidence, then wouldn't the next step be to utilize it?
Not if the evidence contradicts your current beliefs. Then you have a mess on your hands.
Evidence is ignored on a regular basis. And for a variety of reasons - none of which are positive in the long term.
For a runner in today's world, there are countless issues making an appearance in discussions, magazines, and clinics. Many of them focus on running mechanics. Is there a best way to run? Is there not? Should you be a heel striker or mid-foot striker? Is there a benefit to running in a minimalist shoe? Should you run barefoot? The list of burning questions goes on and on and on.
All of these questions focus on issues "below the waist". But the answers don't lie there as we might think. Improving your running mechanics may in fact have little to do with your lower body.
The solutions lie in - the arms? What makes the arms such an important tool in running mechanics?
In Parts I and II of this series, we took a little journey into the world of low back pain. As you look at the signs along the road, you come to realize that the low back pain paradox is reflective of the greater woes of the health care system as a whole. As I mentioned in Part I - as goes low back pain, so goes health care.
Solutions, however, oftentimes look more like a quilt of short-term patches more so than real systemic and cultural change. A little of this, a little of that, but no guiding foundational principles.
With that in mind, let's begin with one of the most important principles: the patient must be at the center of the equation. Solutions lie in the phrase "patient-centered care", not in political agendas or turf wars. If we then use science-based clinical guidelines as a framework for the low back pain paradox, then we stand to create a culture of patient-centered solutions. So what does this framework look like?
I can remember a time not so long ago when only the crazy, hard-core runners would do a marathon. In that same fleeting memory, I can remember a time when only the crazy, hard-core triathletes would do an Ironman. Neither of these was something a sedentary person would even consider, much less put on their bucket list.
Oh, how times have changed. Here we are now in 2013, living in a world in which you can't throw a stone without hitting a marathon or Ironman finisher. In the same breath, however, the incidence of obesity is rising. Somehow there seems to be a growing chasm between the two.
What is going on here?
In Part I of this series, I discussed a few of the reasons that make low back pain such a paradox in health care. The scientific research clearly indicates a disconnect in the health care world - a disconnect between commonly-held beliefs about low back pain, and the evidence that refutes them.
When 97% of low back pain patients present with "mechanical low back pain" - with the majority of those having no specific patho-anatomical diagnosis - we are forced to re-consider the context in which we view the problem itself. This is the only way that we will find solutions and not just stop-gap measures to satisfy the status quo.
So with solutions as our goal, let's take the next step in understanding the paradox. We'll carry on from patient access, head into assessment, and end up with the utilization of services once the patient has access to care.
It was once noted that "every problem contains within itself the seeds of its own solution". With that astute quote in mind, I present to you low back pain: the poster child of all of the health care system's woes and harsh realities.
A total of 31 million Americans experience low back pain at any given point in time. Low back pain affects about 80% of the population at one time or another. If you had those odds in Las Vegas, you would be making a lot of money. Quickly, I might add.
Low back pain also represents the #5 reason for all physician visits, and the second most common symptomatic reason (1,3). The scope and magnitude of the problem is significant. The estimated cost of back pain in the US exceeds $170 billion annually. Yes, billion. That puts it in the same category fiscally as hypertension and diabetes.
It doesn't take the crew of Apollo 13 to establish that yes, Houston, we do have a problem here. It is a problem that is reflective of the woes of the health care system. As goes low back pain, so goes health care costs.
Low back pain is a paradox that contains within itself the seeds of its own solution. But we need to learn from the lessons of 20+ years of spine research – and we need to do so as soon as possible. Let’s start with what may sound like the most basic of questions for patients, clinicians, and legislators: what is low back pain?
Up to 60% of runners will sustain an injury within any given year. Poor running mechanics, in conjunction with poor, ineffective and outdated training methods, can pose a significant injury risk. "RunSmart" was written to address these issues in the running community.
"Running Injuries: Etiology And Recovery- Based Treatment" (co-author Bridget Clark, PT) appears in the third edition and fourth editions of "Clinical Orthopaedic Rehabilitation: A Team Approach" by Charles Giangarra, MD and Robert C. Manske, PT.
Allan Besselink, PT, DPT, Ph.D., Dip.MDT has a unique voice in the world of sports, education, and health care. Read more about Allan here.
Top 5 finalist in three categories: "Best Overall Blog", "Best PT Blog" and "Best Advocacy Blog".
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